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Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L, Awad MM, Haroutounian S. Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104532. [PMID: 38599265 DOI: 10.1016/j.jpain.2024.104532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.
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Affiliation(s)
- Harutyun Alaverdyan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jooyoung Maeng
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Peter K Park
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Kavya Narayana Reddy
- Department of Anesthesiology and Pain Management, Arkansas Children Hospital, University of Arkansas Medical Science, Little Rock, Arkansas
| | - Michael P Gaume
- Department of Pain Management, University of Kansas Health System-St Francis Hospital, Topeka, Kansas
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Michael M Awad
- Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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Lillo-Albert G, Villa EB, Boscà-Robledo A, Carreño-Sáenz O, Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis. Hernia 2024; 28:1427-1439. [PMID: 38837072 DOI: 10.1007/s10029-024-03077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia. METHODS Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI). RESULTS Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92). CONCLUSIONS This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
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Affiliation(s)
| | - Elvira Buch Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
| | - Andrea Boscà-Robledo
- Department of HPB Surgery and Transplantation, La Fe University Hospital, University of Valencia, Valencia, Spain
| | - Omar Carreño-Sáenz
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - José Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jesús Martínez-Hoed
- Unit of Abdominal Wall Surgery. R. A. Calderón Guardia Hospital, San José, Costa Rica
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
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Messias BA, Nicastro RG, Mocchetti ER, Waisberg J, Roll S, Junior MAFR. Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes. Hernia 2024; 28:1467-1476. [PMID: 38900355 PMCID: PMC11297121 DOI: 10.1007/s10029-024-03094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. METHODS PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. RESULTS Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. CONCLUSION The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique.
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Affiliation(s)
- Bruno Amantini Messias
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil.
- Department of Surgery, São Camilo University Center, São Paulo, SP, Brazil.
| | | | - Erica Rossi Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil
| | - Jaques Waisberg
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil
- Department of Surgery, ABC Medical School, Santo Andre, SP, Brazil
| | - Sergio Roll
- Abdominal Wall Surgery Unit, Santa Casa de São Paulo, São Paulo, SP, Brazil
- Hernia Center, Oswaldo Cruz German Hospital, Sao Paulo, SP, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro Junior
- Division Chair Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
- Department of Surgery, Catholic University of São Paulo, Sorocaba, SP, Brazil
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Faessen JL, Stoot JHMB, Broos PPHL, Vijgen GHEJ, Reisinger KW, Bouvy ND, van Vugt R. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia repair under local anesthesia with sedation in the outpatient clinic: a feasibility study. Langenbecks Arch Surg 2024; 409:188. [PMID: 38896330 DOI: 10.1007/s00423-024-03383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. METHODS Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. RESULTS No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5-45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8-42.5) minutes vs. 54.0 (IQR: 46.0-62.0) minutes, P < 0.001) was significantly shorter for TREPP. CONCLUSION This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions.
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Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands.
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - P P H L Broos
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - G H E J Vijgen
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - K W Reisinger
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
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Cirocchi R, Matteucci M, Randolph J, Duro F, Properzi L, Avenia S, Amato B, Iandoli R, Tebala G, Boselli C, Covarelli P, Sapienza P. Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis. World J Surg Oncol 2024; 22:92. [PMID: 38605346 PMCID: PMC11007944 DOI: 10.1186/s12957-024-03374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023. MATERIALS AND METHODS The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google. RESULTS We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I2 = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%). CONCLUSIONS The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy.
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - Francesca Duro
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Bruno Amato
- Department of Public Health, University of Naples "Federico II", Naples, 80131, Italy
| | - Ruggiero Iandoli
- Department of General Surgery, P.O Frangipane Ariano Irpino, Avellino, 83031, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, AOSP of Terni, Terni, 05100, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Paolo Sapienza
- Department of Surgery, "Sapienza" University of Rome, Roma, 00161, Italy
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Directive clinique n o445 : Gestion de la douleur pelvienne chronique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102284. [PMID: 38341222 DOI: 10.1016/j.jogc.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
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Allaire C, Yong PJ, Bajzak K, Jarrell J, Lemos N, Miller C, Morin M, Nasr-Esfahani M, Singh SS, Chen I. Guideline No. 445: Management of Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102283. [PMID: 38341225 DOI: 10.1016/j.jogc.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS RECOMMENDATIONS.
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Raab S, Huber L, Fortelny R, Shamiyeh A. Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (LiquiBandFIX8) for mesh fixation and peritoneal closure: case report about extraperitoneal hematoma. Ann Med Surg (Lond) 2024; 86:481-484. [PMID: 38222725 PMCID: PMC10783228 DOI: 10.1097/ms9.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction A symptomatic inguinal hernia is a prevalent condition that typically requires surgical intervention. Various surgical approaches have been established for hernia repair, including several techniques for peritoneal closure and mesh fixation in laparoscopic surgery. N-butyl-2-cyanoacrylate, such as LiquiBandFIX8, offers a time-saving alternative to invasive methods for both mesh fixation and peritoneal closure. While n-butyl-2-cyanoacrylate is employed in various closure procedures, LiquiBandFIX8 is specifically designed for mesh fixation in inguinal hernia repair. Case presentation We present a case of a 68-year old man undergoing transabdominal preperitoneal inguinal hernia repair under full heparinization. LiquiBandFIX8 was employed for mesh fixation and peritoneal closure. Upon conducting a revision laparoscopy due to a significant postoperative hematoma, we found that the mesh and peritoneum remained undamaged and fully sealed, indicating an effective fixing technique. Both the initial repair and the subsequent revision surgery were documented and the videos were subsequently analyzed. Conclusion LiquiBandFIX8 provides a reliable adhesive strength and appropriate application for peritoneal closure and mesh fixation. When encountering extraperitoneal fluid collection, there is no anticipation of intraabdominal complications.
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Affiliation(s)
- Sandra Raab
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
| | - Livia Huber
- Department for Urology, Hospital Baden-Mödling, Baden, Austria
| | - René Fortelny
- Private Clinic Confraternity, General, and Visceral Surgery, Vienna, Austria
| | - Andreas Shamiyeh
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
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Narita M, Moriyoshi K, Yamaoka R, Moriyama M, Degawa K, Fushitani M, Kojima H, Suenaga T, Nakanishi H, Nishikawa G, Nakanishi Y, Hata H. Intraneural fibrosis within ilioinguinal nerve in inguinal hernia patients with preoperative pain: it's the sign of irreversible nerve injury, isn't it? Langenbecks Arch Surg 2023; 408:431. [PMID: 37940752 DOI: 10.1007/s00423-023-03158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Preoperative pain is known as one of the most powerful risk factors for chronic postoperative inguinal pain (CPIP), while its pathogenesis has not been fully elucidated. The aim of the present study was to evaluate patients with preoperative pain from the pathological perspective and discuss the potential pathogenesis of CPIP in those patients. METHODS This was a single-institutional retrospective study. The study population was inguinal hernia patients with preoperative pain who underwent open anterior hernia repair for primary inguinal hernia with pragmatic ilioinguinal neurectomy during surgery between March 2021 and March 2023. The primary and secondary outcomes were proportion of collagen deposition and mucus accumulation within ilioinguinal nerve in those patients, respectively, which were evaluated histologically using Image J software. RESULTS Forty patients were evaluated. Median value of proportion of intraneural collagen deposition was 38.3% (27.7-95.9). These values were positively correlated with the duration of pain (r2=0.468, P<0.001). Median value of proportion of mucus accumulation in ilioinguinal nerve was 50.1% (0-82.0). These values had no correlation with any clinicopathological variables. CONCLUSIONS In the present study population, all patients with preoperative pain had intraneural fibrosis within ilioinguinal nerve, and its degree had a positive correlation with the pain duration.
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Affiliation(s)
- Masato Narita
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan.
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe City, Japan.
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Ryoya Yamaoka
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Masaaki Moriyama
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Kanako Degawa
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Masashi Fushitani
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroya Kojima
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Takahiro Suenaga
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroki Nakanishi
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Gen Nishikawa
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Yasutaka Nakanishi
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroaki Hata
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
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O'Donnell R, DeFroda S, Bokshan SL, Levins JG, Hulstyn MJ, Tabaddor RR. Cadaveric Analysis of Key Anatomic Structures of Athletic Pubalgia. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00008. [PMID: 37319366 PMCID: PMC10270532 DOI: 10.5435/jaaosglobal-d-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This study proposes to establish in-depth inspection of the anatomic structures involved with the pathology of athletic pubalgia in a cadaver model. METHODS Eight male fresh frozen cadavers were dissected in a layered fashion. The rectus abdominis (RA) and adductor longus (AL) tendon insertions were isolated to quantify the size of the anatomic footprint and distance from the surrounding anatomy. RESULTS The RA insertional footprint was 1.65 cm (SD, 0.18) in width by 1.02 cm (SD, 0.26) in length, and the AL insertional footprint on the underside of the pubis was 1.95 cm (SD, 0.28) in length by 1.23 cm (SD, 0.33) in width. The ilioinguinal nerve was 2.49 cm (SD, 0.36) lateral to the center of the RA footprint and 2.01 cm (SD, 0.37) lateral to the center of the AL footprint. The spermatic cord and the genitofemoral nerve were just lateral to the ilioinguinal nerve and were 2.76 cm (SD, 0.44) and 2.66 cm (SD, 0.46) from the rectus and AL footprints, respectively. CONCLUSION Surgeons should be cognizant of these anatomic relations during both initial dissection and tendon repair to optimize repair and avoid iatrogenic injury to critical structures in the anterior pelvis.
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Affiliation(s)
- Ryan O'Donnell
- From the Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
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11
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Posthuma JJ, Sandkuyl R, Sloothaak DA, Ottenhof A, van der Bilt JDW, Gooszen JAH, Verbeek PCM, In't Hof KH. Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial. Hernia 2023; 27:119-125. [PMID: 35925503 PMCID: PMC9931826 DOI: 10.1007/s10029-022-02651-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10-35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair. METHODS A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation. RESULTS A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed. CONCLUSION We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups.
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Affiliation(s)
- J J Posthuma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | - R Sandkuyl
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - D A Sloothaak
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - A Ottenhof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - J D W van der Bilt
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J A H Gooszen
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P C M Verbeek
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - K H In't Hof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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12
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Taha-Mehlitz S, Taha A, Janzen A, Saad B, Hendie D, Ochs V, Krähenbühl L. Is pain control for chronic neuropathic pain after inguinal hernia repair using endoscopic retroperitoneal neurectomy effective? A meta-analysis of 142 patients from 1995 to 2022. Langenbecks Arch Surg 2023; 408:39. [PMID: 36652009 PMCID: PMC9849289 DOI: 10.1007/s00423-022-02748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Neuropathic pain is a complication after groin hernia surgery. Triple neurectomy of the iliohypogastric nerve, ilioinguinal nerve and genitofemoral nerve is an efficient treatment modality, with several surgical approaches. The minimally invasive endoscopic method to neurectomy was specifically investigated in this meta-analysis. Our aim is to determine the efficacy of this method in the treatment of chronic neuropathic pain posthernia repair surgery. METHODS A systematic review was conducted using four databases to search for the keywords ("endoscopic retroperitoneal neurectomy" and "laparoscopic retroperitoneal neurectomy"). The NCBI National Library of Medicine, Cochrane Library, MEDLINE Complete and BioMed Central were last searched on 26 May 2022. Randomised control trials and retrospective or prospective papers involving endoscopic retroperitoneal neurectomy operations after inguinal hernia repair were included. All other surgeries, procedures and study designs were excluded. The internal quality of included studies was assessed using the Newcastle-Ottawa Scale. The percentage of patients who had reduction in pain ("positive treatment outcome") was used to assess the procedure's effectiveness in each analysis. RESULTS Five comparable endoscopic retroperitoneal neurectomy studies with a total of 142 patients were analysed. Both the Wald test (Q (6) = 1.79, = .775) and the probability ratio test (Q (6) = 4.24, = .374) provide similar findings (0.000, 0.0% [0.0%; 78%]). The meta-analysis' key finding is that the intervention was up to 78% effective (95% confidence interval, 71%; 84%). CONCLUSION Endoscopic retroperitoneal neurectomy can be an effective treatment option for postoperative neuropathic pain relief following surgical hernia repair. Although there is limited reported experience with this technique, it may provide a clinical benefit to the patient. We recommend further prospective data and long-term follow-up studies be conducted to confirm and expand on these outcomes.
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Affiliation(s)
- Stephanie Taha-Mehlitz
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123, Allschwil, Switzerland.
| | - Alex Janzen
- Department of Anesthesia, Greifswald University, 17489, Greifswald, Germany
| | - Baraa Saad
- Faculty of Medicine, St George's University of London, 2062, Nicosia, Cyprus
| | - Dana Hendie
- Department of Surgery, College of Medicine, Sulaiman Al Rajhi University, Albukairyah, Saudi Arabia
| | - Vincent Ochs
- Roche Innovation Centre Basel, Department of Pharma Research & Early Development, 4070, Basel, Switzerland
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Amato G, Agrusa A, Calò PG, Di Buono G, Buscemi S, Cordova A, Zanghì G, Romano G. Fixation free laparoscopic obliteration of inguinal hernia defects with the 3D dynamic responsive scaffold ProFlor. Sci Rep 2022; 12:18971. [PMID: 36347998 PMCID: PMC9643531 DOI: 10.1038/s41598-022-23128-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Laparoscopic TAPP/TEP approaches are well-established options for the cure of inguinal hernias. As in the open approach, mesh fixation and poor-quality biologic response represent controversial questions and are a source of concerns. Furthermore, hernia defect patency represents another problem which seems not well acknowledged among surgeons. These problems are considered the cause of frequent intra and postoperative complications. To overcome these concerns, recently a different concept of cure has emerged. Based on a newly developed dynamic responsive 3D scaffold named ProFlor, a permanent hernia defect obliteration has been finalized. Following its inherent centrifugal expansion due to its dynamic responsivity, this hernia device is positioned fixation free within the defect and induces a probiotic biological response allowing for the re-establishment of the degenerated inguinal barrier. A laparoscopic approach with the 3D scaffold has been tested on 71 patients to demonstrate its effectiveness in reducing intra and postoperative complications. The operated patients presented with bilateral and/or recurrent inguinal hernia. Overall, 122 hernia defects were obliterated with 119 dynamic responsive scaffolds. The procedures were carried out from January 2018 to January 2022 with a defined protocol and detailed procedural steps. The laparoscopic technique with the 3D hernia scaffold allowed for fixation free placement, permanent defect obliteration and dynamically induced regenerative effects. The technique proved effective in reducing intra and postoperative complications. In particular, early postoperative pain and discomfort significantly decreased. No chronic pain and no recurrences were reported during follow up. The results achieved with the described laparoscopic technique seem to embody an innovative concept for inguinal hernia repair. Fixation free, dynamic responsive, permanent defect obliteration, histologically proven regenerative effects are the distinctive features of this 3D scaffold. It seems to embody a more physiological and pathogenetically coherent concept of cure, thus improving treatment results of this widespread disease.
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Affiliation(s)
- Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria 09042 - Monserrato (CA) - ITALY, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Adriana Cordova
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Guido Zanghì
- Department of General Surgery, University of Catania, Via Santa Sofia, 76 - 95123 Catania, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
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14
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Chen J, Glasgow RE. What is the Best Inguinal Hernia Repair? Adv Surg 2022; 56:247-258. [PMID: 36096570 DOI: 10.1016/j.yasu.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the management of inguinal hernias have evolved over hundreds of years, so too has our paradigm of what constitutes the "best repair." To best answer what the ideal inguinal hernia repair is, the authors take an in-depth look at considerations to the patient, the provider, and the health care system.
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Affiliation(s)
- Jennwood Chen
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Veterans Affairs, Department of Surgery, 550 Foothill Dr, Salt Lake City, UT 84113, USA.
| | - Robert E Glasgow
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, 1950 Circle of Hope, Salt Lake City, UT 84112, USA.
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Techapongsatorn S, Tansawet A, Pattanaprateep O, Attia J, Mckay GJ, Thakkinstian A. Mesh-fixation technique for inguinal hernia repair: umbrella review. BJS Open 2022; 6:zrac084. [PMID: 35811449 PMCID: PMC9271883 DOI: 10.1093/bjsopen/zrac084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mesh-based repair is the standard of surgical care for symptomatic inguinal hernias. Many systematic reviews and meta-analyses (SRMAs) addressed various aspects of these procedures. This umbrella review aimed to report the evidence from all previous SRMAs for open and laparoscopic inguinal hernia repair. METHODS SRMAs were identified from MEDLINE, Scopus, Cochrane, Embase, DARE, PROSPERO, CINAHL, JBISRIS, EPPI-Centre, Wiley Online Library and ScienceDirect database according to PRISMA guidelines. Data including mesh-fixation techniques and surgical approach were extracted from selected SRMAs. The corrected covered area was calculated to address study overlap across reviews, and an excess significance test was used to assess potential bias. The outcomes of interest were hernia recurrence, chronic groin pain, operating time, postoperative pain, duration of hospital stay, return to daily life activities, and postoperative complication. RESULTS Thirty SRMAs were included between 2010 and 2019: 16 focused on open repair, and 14 focused on laparoscopic repair, with a high degree of overlap (open repairs, 41 per cent; laparoscopic repairs, 30-57 per cent). Sufficient evidence was available on hernia recurrence, chronic groin pain, and operative time. Effects of glue on hernia recurrence were inconclusive in open and laparoscopy approaches, P = 0.816 and 0.946 respectively. Glue was significantly associated with lower persistent groin pain, in open repair (versus suture) and in laparoscopic repair (versus tack). SRMAs suggested that self-gripping mesh was associated with shorter operating time in open surgery, although with only a few minutes of improvement (0.36-7.85 min, P < 0.001). CONCLUSION In this umbrella review, chronic groin pain and operating time were the only outcomes for which there was sufficient evidence supporting the effectiveness respectively of glue and self-gripping mesh.
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Affiliation(s)
- Suphakarn Techapongsatorn
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- School of Medicine and Public Health, and Hunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales, Australia
| | - Gareth J Mckay
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals. Hernia 2021; 26:225-232. [PMID: 34727286 DOI: 10.1007/s10029-021-02498-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to assess patient's Quality of Life (QoL) after open inguinal hernia repair and to identify predictors of low QoL at 3 months after surgery, to guide practice and inform patients at high risk. METHODS Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors. RESULTS 893 patients were included from 33 hospitals. The majority were men [89.9% (800/891)], had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein's repair [52.9% (472/893)]. The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004). CONCLUSION This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.
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17
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Gamborg S, Öberg S, Rosenberg J. Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study. Scand J Surg 2021; 111:14574969211044030. [PMID: 34657510 DOI: 10.1177/14574969211044030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called "sports groin," which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. METHODS This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998-2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. RESULTS Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. CONCLUSIONS Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.
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Affiliation(s)
- Sara Gamborg
- Center for Perioperative Optimization Department of Surgery Herlev Hospital University of Copenhagen Herlev Ringvej 75 2730 Herlev Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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18
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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19
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Kim SH, Jung HS, Park S, Cho SS. Inguinal hernia repair with or without mesh in late adolescent males. Ann Surg Treat Res 2021; 100:246-251. [PMID: 33854994 PMCID: PMC8019987 DOI: 10.4174/astr.2021.100.4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Inguinal hernia repair is one of the most common treatments worldwide, but there are few studies about the use of mesh in late adolescent patients because hernias are rare in this group. This study aimed to evaluate the postoperative outcomes of hernia repair with and without mesh in late adolescent patients. Methods We retrospectively reviewed the data of 243 male patients aged between 18 and 21 years who underwent inguinal hernia repair at a single institution from January 2013 to December 2017. We distinguished 2 groups depending on the repair method; mesh (n = 121) and no-mesh (n = 122) groups. We compared the baseline characteristics, immediate postoperative outcomes, and recurrence and chronic pain rates between the 2 groups. Results There were no significant differences between the mesh and no-mesh groups on immediate postoperative outcomes (length of stay: 18.5 ± 8.9 days vs. 17.0 ± 6.0 days, P = 0.139; postoperative complications: 8.2% vs. 6.6%, P = 0.821) and 2-year recurrence rate (0.8% vs. 2.6%, P = 0.194). There was a significant difference in the chronic pain rate (9.0% vs. 1.7%, P = 0.023). Conclusion Using mesh for inguinal hernia repair in late adolescent male patients increases chronic postoperative inguinal pain.
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Affiliation(s)
- Sung Hyun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea.,Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Sung Jung
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sejin Park
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Sik Cho
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea.,Department of Surgery, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Liu YM, Feng Y, Liu YQ, Lv Y, Xiong YC, Ma K, Zhang XW, Liu JF, Jin Y, Bao HG, Yan M, Song T, Liu Q. Chinese Association for the Study of Pain: Expert consensus on chronic postsurgical pain. World J Clin Cases 2021; 9:2090-2099. [PMID: 33850928 PMCID: PMC8017506 DOI: 10.12998/wjcc.v9.i9.2090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic postsurgical pain is a common surgical complication that severely reduces a patient’s quality of life. Many perioperative interventions and management strategies have been developed for reducing and managing chronic postsurgical pain. Under the leadership of the Chinese Association for the Study of Pain, an editorial committee was formed for chronic postsurgical pain diagnosis and treatment by experts in relevant fields. The editorial committee composed the main content and framework of this consensus and established a working group. The working group conducted literature review (1989-2020) using key words such as “surgery”, “post-surgical”, “post-operative”, “pain”, “chronic”, and “persistent” in different databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Only publications in the English language were included. The types of literature included systematic reviews, randomized controlled studies, cohort studies and case reports. This consensus was written based on clinical practice combined with literature evidence. The first draft of the consensus was rigorously reviewed and edited by all the editorial committee experts before being finalized. The level of evidence was assessed by methodological experts based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The strength of recommendation was evaluated by all editorial committee experts, and the opinions of most experts were adopted as the final decision. The recommendation level “strong” generally refers to recommendations based on high-level evidence and consistency between clinical behavior and expected results. The recommendation level “weak” generally refers to the uncertainty between clinical behavior and expected results based on low-level evidence.
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Affiliation(s)
- Yi-Ming Liu
- Department of Algology, Peking University People’s Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Algology, Peking University People’s Hospital, Beijing 100044, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yan Lv
- Department of Algology, Air Force Medical University of PLA, Xi’an 710032, Shaanxi Province, China
| | - Yuan-Chang Xiong
- Department of Anesthesiology, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xian-Wei Zhang
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yi Jin
- Department of Algology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou 310058, Zhejiang Province, China
| | - Tao Song
- Department of Algology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, Boselli C, Carlini L, Trastulli S, D'Andrea V, Bruzzone P. Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis. World J Surg 2021; 45:1750-1760. [PMID: 33606079 PMCID: PMC8093155 DOI: 10.1007/s00268-021-05968-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. METHODS We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. RESULTS In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28-0.54; Z = 5.60 (P < 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94-2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24-1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13-0.63; Z = 3.10 (P = 0.002)]. CONCLUSION Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Inguinal Nerve Working Group, Terni, Italy.
| | - Marco Sutera
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Terni, Italy
| | - Piergiorgio Fedeli
- Inguinal Nerve Working Group, Terni, Italy
- School of Law, Legal Medicine, University of Camerino, Camerino, Italy
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Suadoni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Terni, Italy
| | - Luigi Carlini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Vito D'Andrea
- Inguinal Nerve Working Group, Terni, Italy
- Department of Surgical Science, Sapienza Università Di Roma, Rome, Italy
| | - Paolo Bruzzone
- Inguinal Nerve Working Group, Terni, Italy
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza Università di Roma, Rome, Italia
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Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP, TEP and Lichtenstein (SETTLE). Hernia 2021; 25:1309-1315. [PMID: 33400030 DOI: 10.1007/s10029-020-02361-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This pilot trial investigates whether the trans rectus sheath extra-peritoneal (TREPP) mesh repair is a safe and effective procedure compared to the currently most performed inguinal hernia repair techniques TEP and Lichtenstein. METHODS Three hundred patients older than 18 years with unilateral inguinal hernia were included in this retrospective cohort study, of which 58 (19.3%) underwent TREPP, 190 (63.3%) TEP and 52 (17.3%) Lichtenstein. The primary outcome of this study was inguinal hernia recurrence rate within 1 year after surgery. Secondary objectives were chronic post-operative inguinal pain (CPIP) lasting more than 6 months, (major) complication rates and operating time. RESULTS Recurrence rate within 1-year post-operative was low overall in the study population and did not differ significantly between TREPP, TEP and Lichtenstein, respectively 1.7, 2.1, 0.0% (P = 0.591). The rate of CPIP for which the patient contacted the hospital was similar in the study groups: TREPP: 1.7%; TEP: 1.6%; Lichtenstein: 1.9%; (P = 0.591). The mean operating time in minutes (SD) was significantly shorter in the TREPP group compared with the two other patient groups (TREPP: 22.2 (± 5.7); TEP: 38.7 (± 14.8); Lichtenstein: 49.3 (± 17.1), P < 0.001). No major complications occurred in any patient of the study groups. CONCLUSION TREPP seems to be an effective and safe technique for unilateral primary inguinal hernia repair. It is found to be comparable to TEP and Lichtenstein in terms of recurrence rates, chronic post-operative inguinal pain, and clinically significant adverse events. This pilot study proves the need for future research into the TREPP technique.
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23
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Cirocchi R, Mercurio I, Nazzaro C, De Sol A, Boselli C, Rettagliata G, Vanacore N, Santoro A, Mascagni D, Renzi C, Lancia M, Suadoni F, Zanghì G, Palumbo P, Bruzzone P, Tellan G, Fedeli P, Marsilio F, D'Andrea V. Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair. BMC Surg 2020; 20:319. [PMID: 33287793 PMCID: PMC7720581 DOI: 10.1186/s12893-020-00988-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Isabella Mercurio
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy. .,Inguinal NerveWorking Group, Terni, Italy.
| | - Claudio Nazzaro
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Angelo De Sol
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Carlo Boselli
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | | | | | - Alberto Santoro
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Domenico Mascagni
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Renzi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Fabio Suadoni
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Guido Zanghì
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgery, Policlinico Vittorio Emanuele University Hospital-General Surgery and Oncology Unit, University of Catania, Catania, Sicily, Italy
| | - Piergaspare Palumbo
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Paolo Bruzzone
- Inguinal NerveWorking Group, Terni, Italy.,Dipartimento Di Chirurgia Generale E Specialistica "Paride Stefanini", Viale del Policlinico, 155, 00186, Rome, Italy
| | - Guglielmo Tellan
- Inguinal NerveWorking Group, Terni, Italy.,Department of Emergency and Acceptance, Critical Areas and Trauma, "Umberto I" University Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Piergiorgio Fedeli
- Inguinal NerveWorking Group, Terni, Italy.,Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Francucci Marsilio
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Vito D'Andrea
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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The outcomes of routine ilioinguinal neurectomy in the treatment of chronic pain during herniorrhaphy: A meta-analysis of randomized-controlled trials. Asian J Surg 2020; 44:431-439. [PMID: 33250275 DOI: 10.1016/j.asjsur.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022] Open
Abstract
The study aimed to evaluate whether an intraoperative ilioinguinal neurectomy (IIN) would reduce the risk of postoperative pain without increasing other complications during tension-free mesh repair compared to those who accepting nerve preservation. We have searched the following databases: PubMed, Cochrane Library, and EMBASE from inception to January 2020 (the cut-off date was 1 January 2020). Two authors independently accomplished the study selection, data extraction, and quality assessment. Of 553 studies reviewed, 7 high-quality randomized-controlled trials (RCTs) were identified. We pooled the related effect values in each included study and conducted a meta-analysis. The pooled results showed that IIN could reduce postoperative pain rate (RR = 0.40, 95% CI: 0.17-0.95) and pain score (SMD = -0.26, 95%CI: -0.46 to -0.06) at 6 months. There are no statistical differences between postoperative numbness rate (RR = 1.48, 95%CI: 0.89-2.47), postoperative sensory disturbance (RD = 0.03, 95% CI: -0.03-0.1) and postoperative secondary complications rate (RR = 0.81, 95%CI: 0.53-1.24) at the same time point. In conclusion, we have found the routine IIN can reduce the incidence of postoperative pain without increasing complications. Therefore, the implementation of this simple intraoperative maneuver may be a major source of postoperative morbidity reduction. Further study on the evaluation of interventions targeted to the IIN is recommended.
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25
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Protasov AV, Kulchenko NG, Vinogradov IV. [Association of tension-free inguinal hernia repair and pathospermia in fertile men]. Khirurgiia (Mosk) 2020:44-48. [PMID: 33047585 DOI: 10.17116/hirurgia202010144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To reveal the association of tension-free inguinal hernia repair and pathospermia in fertile men. MATERIAL AND METHODS We have retrospectively analyzed medical records of 512 men who appealed to andrologist with complaints of the absence of pregnancy in wife in 2018. We evaluated duration and features of infertility, presence/absence of previous inguinal hernia repair, spermogram data (according to WHO criteria, 2010) in all patients. RESULTS Duration of infertility in men after inguinal hernia repair persists for 4.2±2.1 years. Right-sided hernia repair was performed in 36 (48.6%) patients, left-side - 23 (31%), bilateral repair - 15 (20.2%) patients. Men with impaired sperm motility prevailed among patients after right-sided inguinal hernia repair (17 (47.2%) people). Left-sided hernia repair was followed by asthenozoospermia in 8 (34.7%) cases, bilateral hernia repair - in 3 (20%) cases. The most severe abnormalities in semen analysis (azoospemia) develop after bilateral hernia repair. CONCLUSION Inguinal tension-free hernia repair is a risk factor for male infertility in 14.4% of cases. It is very important to examine a man in case of infertile marriage. Previous surgical interventions including inguinal hernia repair should be considered.
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Affiliation(s)
- A V Protasov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - N G Kulchenko
- Peoples' Friendship University of Russia, Moscow, Russia
| | - I V Vinogradov
- Peoples' Friendship University of Russia, Moscow, Russia
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26
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Sartori A, De Luca M, Noaro G, Piatto G, Pignata G, Di Leo A, Lauro E, Andreuccetti J. Rare Intraoperative and Postoperative Complications After Transabdominal Laparoscopic Hernia Repair: Results from the Multicenter Wall Hernia Group Registry. J Laparoendosc Adv Surg Tech A 2020; 31:290-295. [PMID: 32808863 DOI: 10.1089/lap.2020.0459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence.
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Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giulia Noaro
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giacomo Piatto
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili, Brescia, Italy
| | - Alberto Di Leo
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
| | - Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Jacopo Andreuccetti
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
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27
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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28
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Surgical treatment for chronic postoperative inguinal pain-short term outcomes of a specialized center. Am J Surg 2020; 219:425-428. [DOI: 10.1016/j.amjsurg.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
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29
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Rausa E, Asti E, Kelly ME, Aiolfi A, Lovece A, Bonitta G, Bonavina L. Open Inguinal Hernia Repair: A Network Meta-analysis Comparing Self-Gripping Mesh, Suture Fixation, and Glue Fixation. World J Surg 2019; 43:447-456. [PMID: 30251208 DOI: 10.1007/s00268-018-4807-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The most troublesome complications of inguinal hernia repair are recurrent herniation and chronic pain. A multitude of technological products dedicated to abdominal wall surgery, such as self-gripping mesh (SGM) and glue fixation (GF), were introduced in alternative to suture fixation (SF) in the attempt to lower the postoperative complication rates. We conducted an electronic systematic search using MEDLINE databases that compared postoperative pain and short- and long-term surgical complications after SGM or GF and SF in open inguinal hernia repair. Twenty-eight randomized controlled trials totaling 5495 patients met the inclusion criteria and were included in this network meta-analysis. SGM and GF did not show better outcomes in either short- or long-term complications compared to SF. Patients in the SGM group showed significantly more pain at day 1 compared to those in the GF group (VAS score pain mean difference: - 5.2 Crl - 11.0; - 1.2). The relative risk (RR) of developing a surgical site infection (RR 0.83; Crl 0.50-1.32), hematoma (RR 1.9; Crl 0.35-11.2), and seroma (RR 1.81; Crl 0.54-6.53) was similar in SGM and GF groups. Both the SGM and GF had a significantly shorter operative time mean difference (1.70; Crl - 1.80; 5.3) compared to SF. Chronic pain and hernia recurrence did not statistically differ at 1 year (RR 0.63; Crl 0.36-1.12; RR 1.5; Crl 0.52-4.71, respectively) between SGM and GF. Methods of inguinal hernia repair are evolving, but there remains no superiority in terms of mesh fixation. Ultimately, patient's preference and surgeon's expertise should still lead the choice about the fixation method.
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Affiliation(s)
- Emanuele Rausa
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy.
| | - Emanuele Asti
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy
| | | | - Alberto Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy
| | - Andrea Lovece
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milano, Italy
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30
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Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia 2019; 23:473-484. [PMID: 31089835 DOI: 10.1007/s10029-019-01964-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The Open Lichtenstein technique, the Laparoscopic Trans-Abdominal PrePeritoneal (TAPP), the Totally Extra Peritoneal (TEP), and the robotic TAPP (rTAPP) are commonly performed. The aim of the present network meta-analysis was to globally compare short-term outcomes within these major surgical techniques for primary unilateral inguinal hernia repair. METHODS PubMed, EMBASE, and Web of Science were consulted. A fully Bayesian network meta-analysis was performed. RESULTS Sixteen studies (51.037 patients) were included. Overall, 35.5% underwent Open, 33.5% TAPP, 30.7% TEP, and 0.3% rTAPP. The postoperative seroma risk ratio (RR) was comparable considering TAPP vs. Open (RR 0.91; 95% CrI 0.50-1.62), TEP vs. Open (RR 0.64; 95% CrI 0.32-1.33), TEP vs. TAPP (RR 0.70; 95% CrI 0.39-1.31), and rTAPP vs. Open (RR 0.98; 95% CrI 0.37-2.51). The postoperative chronic pain RR was similar for TAPP vs. Open (RR 0.53; 95% CrI 0.27-1.20), TEP vs. Open (RR 0.86; 95% CrI 0.48-1.16), and TEP vs. TAPP (RR 1.70; 95% CrI 0.63-3.20). The recurrence RR was comparable when comparing TAPP vs. Open (RR 0.96; 95% CrI 0.57-1.51), TEP vs. Open (RR 1.0; 95% CrI 0.65-1.61), TEP vs. TAPP (RR 1.10; 95% CrI 0.63-2.10), and rTAPP vs. Open (RR 0.98; 95% CrI 0.45-2.10). No differences were found in term of postoperative hematoma, surgical site infection, urinary retention, and hospital length of stay. CONCLUSIONS This study suggests that Open, TAPP, TEP, and rTAPP seem comparable in the short term. The surgical management of inguinal hernia is evolving and the effect of the adoption of innovative minimally invasive techniques should be further investigated in the long term. Ultimately, the choice of the most suitable treatment should be based on individual surgeon expertise and tailored on each patient.
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Berri T. Chronic neuropathic pain following inguinal hernia repair. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_125_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Grayson CT, Criman ET, Cefalu LM, Roedel EQ, Hong SS, Yheulon CG. Litigation Patterns in Inguinal Hernia Surgery: A 25 Year Review. J Surg Res 2018; 232:266-270. [DOI: 10.1016/j.jss.2018.06.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
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